36-129 (3) i
// PERMIT APPLICATION CHECK LIST
PAGE 274 PLOT / 9 ZONE 4 '� E`S NO DATE
1 . ZONING FORM APPLICATION `� t:5l y
2 . PERMIT APPLICATION C_-
3 . OWNER OCCUPANT STATEM 'T LIC . # IF NOT L/
4 . �3 SETS OF P S PLOT PL N �
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER VAI BIL T FORMS
8 . REMODELING INTERIOR
ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
2 . PERMIT FEE - -CHECK ONLY - MONEY ORDER 4�"-71( C/"
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTWNT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass, 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION: Z ss 7
(Map) (Parcel) (subdivision)
HOMEOWNER: /✓'rP�/ /" , . �/�✓/% /✓ �✓i/�C
(Name & Address)
J� _ f /
(Home Phone) (Work Phone)
The current exemption for "homeownpr,s" -W s extended to include
Owner-occupied Dwellings of one ( 1 ) or two (2) families and to allow such
homeowner to engage an individual for hire who doeG not possess a __-
license, provided that the owner acts as supervisor.' CMR780 Section 109. 1 .1
DEFINITION OF HOMEOWNER: Person s ) who own a parcel of land on
which he/she resided or intends to reside, on which there is, or is
intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures . A person who
constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building
Official, on a form acceptable to the Building Official, that he/she
shall be responsible for all such work performed under the building
permit.
As acting Construction Supervisor your presence on the job site
will be required from time to time , during and upon completion of the
work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers '
Compensation) and Chapter 153 (Li-ability of Employers to Employees for
injuries not resulting in Death) of the Massachusetts General Laws
Annotated, you may liable for person (s) you hire to perform work for
you under this permit .
The undersigned "homeowner" certifies and assumes responsibility
for compliance with the State Building Code, City of Northampton
Ordinances, State and Local Zoning Laws , and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURES
BUILDING PERMIT # �!
1
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER U
SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE UU'�
SURVEY AND IS NOT TO BE RECORDED.
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I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #
SURVEYOR: :R -NOTE-
D-- THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
MORTGAGE LOAN INSPECTION PLAT-
RANLAII
IZER
�3RO�t
fES
HAROLD L. EATON AND ASSOCIATES, INC.
--- REGISTERED PROFESSIONAL LAND SURVEYORS
�• �' 235 RUSSELL STREET - HADLEY - MASSACHUSETTS
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S�` "� �� Alterations
NORTHAMPTON, MASS. Z.3
Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 2 7 /���� c �,� = ��`i Lot No. Z-
2. Owner's name /)-7 1W V /99 67/ Address Z'L
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition ox ! z /DC TR C
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- Oct
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
F ( Signature of responsible appicant
i
Remarks
Rt Pp
_ sir.►
Date Filed �G� q V File No.
ZONING PERMIT APPLICATION (§10.2)
I. Name of Applicant: ARY %,A, 6,
Address: 2�S7 �, 00�s�,�c- <i�;ic" `- ,2Cc - Telephone:
2 . Owner of Property:
Address: ? -7 j3� c��s �7�� ��rCCC Telephone: S- �/- c- 5,r
3 . Status of Applicant: ,/owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District (s) (include overlay ) O/
Street Address � '�
Required
5.
Existing Pro osed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L - ` R -
- rear i - r 1 i
Lot size k gS' 2
Frontage
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Descri ption of Proposed Work/Project: (Use additional sheets
if necessary) v; I ,, �_ 9 -2 ' S7c w
�% t
7 . Attached Plans: Sketch Plan t, Site Plan
, 8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: 3� Applicant's Signature:
-
-- -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -
THIS SECTION FOR OFFICIAL USE NLY:
�Approved as resented ase P /b d on information presented
Den 'ed as presented
so or 'al:
gnatu of uilding I ector
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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